Brief Communication
Type 1 diabetes mellitus in Bhutan Tashi Wangdi Department of Medicine, National Referral Hospital, Thimphu, Kingdom of Bhutan
A B S T R A C T Bhutan is a South Asian country with a total population of 733,643. Bhutan has a very low burden of type 1 diabetes mellitus (T1DM), while that of type 2 diabetes mellitus is very high and increasing at alarming rates. Bhutan has a notably high proportion of over‑weight and obese population. First case of T1DM was detected in 2006 and all the detected patients are in the age range of 14–15 years. The challenges in T1DM management include lack of knowledge among health care workers and patients, and limited access to health care services because of the difficult terrain. Key words: Bhutan, diabetes, type 1 diabetes mellitus
Introduction The total population of Bhutan is 733,643. 27.3% of this is in the age group of 0–14 years, and 20% in the age group of 15–24 years. The health expenditure share in the country in 2011 was 4.1%. The life expectancy at birth in Bhutan has increased from 66.1 in 1994 to 68.9 in 2010. The crude birth rate (births per 1000 population) has decreased consistently from 39.9 in 1994 to 17.9 in 2012, and crude death rate (deaths per 1000 population) from 9.0 in 1994 to 6.2 in 2012. There has been a consistent decrease in the under‑five mortality rate (deaths per 1000 live births) from 96.9 in 1994 to 37.3 in 2012, in infant mortality rate (deaths per 1000 live births) from 70.7 in 1994 to 30.0 in 2012, and in maternal mortality ratio (deaths per 100,000 live births) from 380 in 1994 to 86 in 2012. The sex ratio at birth (males per 100 females) has remained almost the same from 105 in 1994 to 104 in 2012.[1] Bhutan has a very low burden of type 1 diabetes mellitus (T1DM), while that of type 2 diabetes mellitus (T2DM) Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.155349
is very high and increasing at alarming rates. There have been different figures, quoted by different studies, regarding the T1DM prevalence in Bhutan, in past. WHO has also conducted a survey and the results are expected to be published shortly. Bhutan, despite being a hilly country where people are forced to undergo high daily physical stress, has a notably high proportion of over‑weight and obese population. The steps survey in 2007 reported hypertension in 26% of the population, T2DM in 8.2%, impaired fasting glucose in 21.6%, overweight in 52.4%, obesity in 12.1%, and hypertriglyceridemia in 21%, with 5.6% daily smokers, and 82.9% not engaging in vigorous physical activity. The incidence of diabetes per 10,000 population has increased consistently from 38 in 2009 to 80 in 2013.[2] The dietary habits of people in Bhutan include suja (salted butter tea) in 56.7% of the population, Ezay (salted chili pickle) in 55.5%, dry meat in 25.1%, whereas two‑thirds of the population consume fruits with
Type 1 diabetes mellitus in Bhutan Tashi Wangdi Department of Medicine, National Referral Hospital, Thimphu, Kingdom of Bhutan
A B S T R A C T Bhutan is a South Asian country with a total population of 733,643. Bhutan has a very low burden of type 1 diabetes mellitus (T1DM), while that of type 2 diabetes mellitus is very high and increasing at alarming rates. Bhutan has a notably high proportion of over‑weight and obese population. First case of T1DM was detected in 2006 and all the detected patients are in the age range of 14–15 years. The challenges in T1DM management include lack of knowledge among health care workers and patients, and limited access to health care services because of the difficult terrain. Key words: Bhutan, diabetes, type 1 diabetes mellitus
Introduction The total population of Bhutan is 733,643. 27.3% of this is in the age group of 0–14 years, and 20% in the age group of 15–24 years. The health expenditure share in the country in 2011 was 4.1%. The life expectancy at birth in Bhutan has increased from 66.1 in 1994 to 68.9 in 2010. The crude birth rate (births per 1000 population) has decreased consistently from 39.9 in 1994 to 17.9 in 2012, and crude death rate (deaths per 1000 population) from 9.0 in 1994 to 6.2 in 2012. There has been a consistent decrease in the under‑five mortality rate (deaths per 1000 live births) from 96.9 in 1994 to 37.3 in 2012, in infant mortality rate (deaths per 1000 live births) from 70.7 in 1994 to 30.0 in 2012, and in maternal mortality ratio (deaths per 100,000 live births) from 380 in 1994 to 86 in 2012. The sex ratio at birth (males per 100 females) has remained almost the same from 105 in 1994 to 104 in 2012.[1] Bhutan has a very low burden of type 1 diabetes mellitus (T1DM), while that of type 2 diabetes mellitus (T2DM) Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.155349
is very high and increasing at alarming rates. There have been different figures, quoted by different studies, regarding the T1DM prevalence in Bhutan, in past. WHO has also conducted a survey and the results are expected to be published shortly. Bhutan, despite being a hilly country where people are forced to undergo high daily physical stress, has a notably high proportion of over‑weight and obese population. The steps survey in 2007 reported hypertension in 26% of the population, T2DM in 8.2%, impaired fasting glucose in 21.6%, overweight in 52.4%, obesity in 12.1%, and hypertriglyceridemia in 21%, with 5.6% daily smokers, and 82.9% not engaging in vigorous physical activity. The incidence of diabetes per 10,000 population has increased consistently from 38 in 2009 to 80 in 2013.[2] The dietary habits of people in Bhutan include suja (salted butter tea) in 56.7% of the population, Ezay (salted chili pickle) in 55.5%, dry meat in 25.1%, whereas two‑thirds of the population consume fruits with
